There are but few diseases which are not attended to a greater or less extent with gastric symptoms. Every constitutional or local disease, febrile and afebrile processes, are all more or less complicated with disturbances of the digestive organs. The digestive symptoms in all these conditions, however, are dependent upon a general disturbance of the entire organism and are not due to real affections of the digestive organs. They are therefore always discussed in the symptomatology of the different diseases. In the following we shall briefly describe the condition of the stomach in several organic diseases of other organs, wherein the gastric symptoms play a predominant part. In fact, in many cases it is quite difficult to recognize the secondary nature of the gastric trouble, the primary disease giving so few and unimportant symptoms that it is easily overlooked.

Tuberculosis Of The Lungs

As is well known, in pulmonary tuberculosis the symptoms of the gastrointestinal tract are frequently very pronounced and very difficult to manage; often there exist loss of appetite, disagreeable sensations after meals, belching, bad taste, constipation alternating with diarrhoea, and last, but not least, severe and obstinate gastralgia as well as enteralgia. While these gastric symptoms, as. a rule, appear when the tuberculous process in the lungs is already quite advanced, occasionally they may exist long before there is any evidence of a real lung trouble. While the pathological anatomy of the stomach in tuberculous patients has been examined by W. Fenwick,1 who found well-marked evidence of gastric catarrh in eleven out of fifteen cases of phthisis, the functions of the stomach in this affection have been studied by Rosenthal,2 Edinger,3 Klemperer4 and Schetty,5 Brieger,6 Hildebrandt,7 Immermann,8 and myself.9 My own conclusions, which harmonize well with those of most of the writers just mentioned, were published in the Medical Record of May 4th, 1889, and are as follows:

1. Among the fifteen cases of phthisis pulmonura examined, free hydrochloric acid was absent in two only (Nos. 14 and 15); in a third patient (No. 11) the hydrochloric acid was wanting but once, and was present at two other examinations; in all the other patients the hydrochloric acid was always present.

2. As regards acidity, in five patients (Nos. 6 to 10) it was found normal; five (Nos. 1 to 5) showed hyperacidity; and five (Nos. 11 to 15), a diminution in the degree of acidity; among the last group there were two with a total absence of free hydrochloric acid.

1W. Fenwick: Virchows' Arch., 1889, p. 187. 2C. Rosenthal: Bed. klin. Wochenschr., 1888, No. 45. 3Edinger: Deutsch. Arch. f. klin. Med., 1881. 4Klemperer: Rerl. klin. Wochenschr., 1889, No. 11. 5F. Schetty: Deutsch. Arch. f. klin. Med., Bd. 44, p. 219. 6Brieger: Deutsch. med. Wochenschr., 1888, No. 14. 7Hildebrandt: ibidem, 1889, No. 15.

8Immermann: Verhandl. des Congresses f. innere Medicin. Wiesbaden, 1889.

9Max Einhorn: Medical Record. May 4th. 1889.

3. Only one patient (No. 4) had in his stomach, after the test breakfast, the remnants of the yolk of an egg which he had eaten on the day previous, and that but once. In all other patients no food whatever was found in the stomach except the fine pieces of the roll. The stomach must have been empty before taking the breakfast, and therefore it can be concluded that the motor power of the stomach was not diminished in a very high degree.

4. In most cases a record of the appetite was kept. A priori, one would be inclined to think that the appetite is in a certain degree dependent upon the amount of gastric juice secreted. As the amount of gastric juice secreted is measured by the degree of acidity, the appetite ought to be good where hyperacidity or a normal amount of acidity exists, and bad where there is present a diminished degree of acidity. But this is not true; three patients with hyperacidity (Nos. 1, 3, and 4), and two with normal acidity (Nos. 8 and 10), complained of poor appetite, whereas patient No. 15 had a good appetite, although there was complete absence of free hydrochloric acid in his stomach.

It will be seen that frequently the subjective symptoms do not harmonize with the objective data found in a thorough examination of the stomach. The point to be gained from this fact with regard to treatment is not to be afraid of giving sufficient food to these patients with markedly disturbed appetite and many other dyspeptic symptoms. In fact, gavage or forced alimentation will often prove very useful. Debove, Peiper, Leyden, and others have obtained the most beneficial results in phthisical patients by this method.

The treatment of the gastric symptoms, in which certain functional anomalies of the stomach (as for instance hyperchlorhydria or hypochlorhydria) have been found, will be similar to that described under the head of these latter conditions. The main treatment, however, must always be directed against the primary affection, namely, the lung trouble.

Tuberculous ulcers of the stomach are occasionallv met with, especially in association with tuberculous lesions of other organs. Their occurrence has been described by several writers (Eppinger,l Litten,2 Musser3).